Improving criteria for dissemination in space in multiple sclerosis by including additional regions

Area of Science:

• Neurology
• Radiology
• Immunology

Background:

• Dissemination in space (DIS) criteria are crucial for diagnosing multiple sclerosis (MS).
• Current DIS criteria may benefit from incorporating additional anatomical regions for improved diagnostic accuracy.
• Evaluating the impact of expanded MRI regions on MS diagnosis is essential.

Purpose of the Study:

• To investigate the effect of including additional anatomical regions in the dissemination in space (DIS) criteria for multiple sclerosis (MS) diagnosis.
• To assess the diagnostic performance of modified DIS criteria using MRI of the brain, optic nerve, and spinal cord.
• To determine optimal criteria modifications for enhancing MS diagnosis sensitivity and specificity.

Main Methods:

• Eighty-four participants underwent brain, optic nerve, and spinal cord MRI.
• Dissemination in space (DIS) criteria were assessed using the 2017 McDonald criteria and modified versions.
• Modified criteria included the optic nerve, temporal lobe, or corpus callosum as a fifth region, or all regions, with varying required lesion counts.

Main Results:

• The 2017 McDonald DIS criteria showed 87% sensitivity and 73% specificity for MS identification.
• Including the optic nerve as a fifth region significantly improved sensitivity to 98% but reduced specificity to 33%.
• Modified criteria requiring 3/7 regions (including all three) demonstrated 95% sensitivity and 55% specificity, while 4/5 regions (optic nerve focus) achieved 95% specificity but only 56% sensitivity.

Conclusions:

• Incorporating the optic nerve into DIS criteria enhances sensitivity for MS diagnosis.
• Adjusting the number of required regions in modified DIS criteria balances sensitivity and specificity.
• Consideration of the optic nerve and specific region combinations (e.g., 3/5 or 4/5 regions) may optimize MS diagnostic accuracy.